Healthy Living

A Word About Nurse Champions

2008-10-03T10:53:00.000-07:00

By Susan Hecht, RN
Nursing Rehabilitation Liaison

A nurse is one who plays a role in the responsibility for treatment, safety and recovery of ill or injured people. A champion is an ardent defender or supporter of a cause. While each nurse has a unique background we share the same passion for nursing.

A Nurse Champion works usually within their unit (but not limited to) to support change. It is not always battling the odds but a superb opportunity to develop professionally. According to the Center for Studying Health System Change, “Nurses are the largest deliverer of health care in the U.S.” One of the most important outcomes in being a Nurse Champion is an increased comfort in working with projects, increasing job satisfaction and stronger team relationships.

What makes a Champion Nurse? I believe you have to like challenges. They focus on health and wellness, they advocate for their patients, they always have a mission, they consider their work to be a privilege, they are innovative and creative, they are opportunistic people always looking for a chance to improve, they take pride in their nursing, and last but not least, they support the mission of their organization.

Prior to coming to Saint Francis Hospital I worked as an LPN for 5 years in a Long Term Facility. I have been at Saint Francis for 9 years. I have been an LPN, RN, Nursing Rehabilitation Liaison and I’m currently going for my BSN. Through every turn in my 9 years I have felt the desire to take on challenges. I enjoy taking on a challenge and running with it. I enjoy teaching and advocating for my patients and the community.

According to the September 2008 American Journal of Health System Pharmacists, “More than 2 million Americans are affected by Deep Vein Thrombosis (DVT) annually, with 600,000 developing PE (pulmonary embolism) leading to 60,000 deaths. Venous Thromboembolism (VTE) is recognized as the most preventable cause of inpatient mortality.”

I am a Nurse Champion for DVT Prevention.

· I have arranged in-service luncheons on DVT Prevention for student nurses to promote awareness and prevention.
· I have attended health fairs for Saint Francis Hospital promoting DVT Awareness and Prevention.
· Every March (DVT Awareness month) I initiate a hospital-wide effort to raise awareness of this condition within out organization.
· I spear-headed an event in September 2007 bringing Melanie Bloom to the hospital to speak on the subject. She joined the Coalition to Prevent Deep Vein Thrombosis and became its national spokesperson following the death of her husband, David (an NBC correspondent and father of three) from PE while covering the Iraq War. The event with Melanie brought more than 250 to our Community Conference Center.
· I was recently involved in updating our Admission Nursing Assessment form to include a VTE component.
· As part of my pursuit of a BSN at SUNY New Paltz, I am engaged in an education project regarding DVT Awareness, Prevention and Prophylaxis.

I believe in my ability to take on new challenges, embrace them and grow from them, as well as continue to educate and allow experiences to open new doors for me.

I believe in the term Nurse Champion!

Some Facts About Medicare

2008-08-28T10:46:00.000-07:00

By Frances T. Traver
Manager, Clinical Services
Saint Francis Home
Care Services, Inc.

Saint Francis Hospital’s Home Care Services, Inc., the Certified agency, often receives calls about types of assistance available for those recovering from an illness or injury.
While we accept Medicare payments, Medicare requires that your condition meets certain requirements before we can assign you a nurse or therapist.
Your physician must agree you need home care services and needs to guide our staff regarding your needs. We stay in contact with your physician throughout your care.
Second, the care you receive may require the skill of a professional nurse or therapist. Medicare has guidelines. For example, a nurse may help you with wound care or injections. Medicare would also cover a nurse to assess the status of your illness. If you have a heart condition for which you were recently hospitalized, Medicare would cover for a nurse to come to your home to assess blood pressure and heart rate. However, once you are doing better Medicare would no longer cover a nurse to assess the condition.
Medicare also would cover a professional nurse to teach you to manage your illness. Our staff demonstrates good outcomes with their ability to teach patients to care for themselves at home. A nurse may teach a diabetic how to use a glucose monitoring machine or teach a client about medication and how to better manage their side effects. Medicare will also cover for a nurse to teach you to inject insulin at home. But not to come to your home to give insulin injections.

You must be “homebound” to receive home care services in your home. Medicare defines homebound as taxing for you to leave your home. This does not mean you need to be in bed. But if you leave home it can only be for short durations or to receive medical treatments, such as chemotherapy.

Just as important as what Medicare benefits will pay, is what Medicare benefits will not cover. They will not cover aide services unless you have one of the skilled services discussed above. Medicare will only pay for the aide to assist with personal care, such as bathing. Medicare will not pay for housekeeping services.

Medicare benefits are there when you need them in the home. Saint Francis Home Care Services, Inc (Certified agency) can bill Medicare directly to cover needed services. Please feel free to call us (845-483-5550) about your Medicare benefits for home care services. You may also call your Medicare office for more information about home care benefits.

Yogurt Sense

2008-08-15T07:11:00.000-07:00

By Joanne Chaconis, RD
Chief Clinical Dietician

It’s been around forever and it is a real powerhouse food. With calcium, protein and probiotics, yogurt “packs a punch.“ But as with most foods we find in our grocery aisles, there are many varieties to choose from. I hope the following guidelines are helpful:

The choice is up to you – whether you choose plain, unflavored, a traditional flavor like vanilla or strawberry, or some of the more contemporary flavors like kiwi lime pie, just use the following as guidelines for making an educated choice (per eight ounces) :

1.) No more than 200 calories. Remember that yogurt is processed mainly from milk (skim milk being about 80 calories per cup ). That means that extra ingredients should not be contributing an abundance of extra calories.
2.) Four grams of fat or less. No other fat is added to yogurt. If a label says more than four grams of fat, that means that whole milk or even cream was used.
3.) 30 grams of sugar or less. Milk naturally contains about 12 grams of sugar (lactose) per cup. Anything over that comes from fruit, honey, or sugar.
4.) At least six grams of protein. Less than that would suggest that the protein has been watered down with ingredients, such as sugar.
5.) At least 20 % of your daily value for calcium. That equals to 200 mg. (based on 1000 -1200 mg daily ).

Also, look for live active cultures. Known as “probiotics,” they may boost immunity and help prevent or manage constipation, diarrhea, bloating. Look for L. acidophilus and/or B. bifidum as these are the more potent forms.

Other points to consider: fruit flavored yogurts do not count as a fruit serving. If that is your aim, just add a cup of sliced fresh fruit to a small container of plain, fat free yogurt. If you prefer a drinkable yogurt, use the aforementioned points as your guide. And if you prefer or need to choose a soy yogurt, go ahead. Aside from it being made from soy rather then cow’s milk, the benefits/content are usually the same.

Maintaining Independence At Home

2008-08-08T07:25:00.000-07:00

By Nicole Peluse Gesh,
Manager, Licensed Home Care

One of the greatest desires heard by home care professionals is to maintain independence and remain at home. This is why home care continues to expand its service menu. It is estimated that more than half of all falls resulting in injury occur at home. There are several preventative measures to help prevent falls from occurring:
- Tack rugs and flooring so they are flat.
- Be sure carpets and runners are fully attached to stairs.
- Do not stand on a chair to reach things. Keep regularly used items within easy reach.
- Be sure and have lights easily turned on when getting out of bed.
- Use canes and walkers as directed by your healthcare provider.
- Understand medications that can cause dizziness or drowsiness.
- Exercise regularly as directed by your healthcare provider.
The Lifeline personal care system can not only help save a life, but help preserve a cherished way of life by giving seniors the confidence to continue living in their own homes. Lifeline is not just for the wearer, it provides great peace of mind for the caregiver(s). An accident can happen in a split second, a medic-alert system gets help instantly. The buttons are simple, small and easy to use. They are meant to wear in bed and in the shower.
Lifeline is one of the many products and services available through Saint Francis Home Care Services, Inc. These are designed to keep patients at home and enjoying their regular activities. Often, people will shy away from the idea of a medic alert system. Many caregivers achieve success by giving it as a gift. Explaining they will take comfort in knowing the patient has the security. It isn’t just for falls, one patient woke up, didn’t feel quite right and pushed his Lifeline without getting out of bed. Another patient heard someone at the door and she felt uneasy. She pushed the Lifeline button and was connected with help.

Home Care has so much to offer both patients and caregivers. The message is to not only ask for help, but to accept the levels of support that meet the needs of your situation!

Food Allergy FAQ

2008-08-07T06:43:00.000-07:00

By Sarah Daubman, RD
Staff Dietician

What exactly is a food allergy?

A true food allergy involves an immune system response from the body. The body identifies an offending food as harmful and releases antibodies to attack it. This triggers the release of histamine, thus precipitating the outward symptoms of an allergic reaction. These may include itching in or around the mouth, hives, nausea, stomach pain, difficulty breathing and/or anaphylaxis. Most often, people need to ingest the food for the allergic reaction to occur, but certain sensitive individuals may develop symptoms from touching the food or inhaling steam from which the food is being prepared (as in cooking shellfish).

How is that different from food intolerance?

Like a food allergy, a food intolerance is also an adverse reaction to food, but the body’s immune system is not involved. Lactose intolerance, for example, is when the body lacks the enzyme lactase needed to digest lactose, the sugar found in milk. Without the enzyme present, lactose remains undigested and ferments in the gut, resulting in gastrointestinal (GI) symptoms such as diarrhea, bloating or constipation. Lactose intolerance is therefore not the same as a milk allergy, which would involve the type of allergic reaction described above. The cause of other food intolerances may not be as easily identified but may trigger similar GI symptoms.

What are typical food allergies?

Unfortunately, any food can be a food allergy but eight foods account for more than 90 percent of them: egg, milk, wheat, soy, fish, shellfish, peanuts and tree nuts. Certain food allergies that appear in childhood may disappear as the child grows (milk, eggs, soy and wheat), but others (peanuts, fish and shellfish) typically never go away.

How are food allergies diagnosed?

Clinical testing for diagnosing a food allergy may include a skin prick test or blood testing. An elimination diet may also be recommended to assess whether removing the suspected food from the diet results in an alleviation of symptoms.

How are food allergies treated?

The only treatment for food allergies is to eliminate the food from the diet. In a case of multiple food allergies, a visit to a Registered Dietitian may be recommended to avoid any dietary deficiencies.

Where can I get more information?

About food allergies:
The Asthma and Allergy Foundation of America
www.aafa.org

The Food Allergy and Anaphylaxis Network
http://www.foodallergy.org/about.html

The American Pediatric Association
http://www.aap.org/healthtopics/asthma.cfm

To find a Registered Dietitian in your area:
www.eatright.org and click on “Find a Nutrition Professional” on the right hand side.

Sports Related Concussions, Part 2

2008-07-23T11:02:00.000-07:00

By Jean M. Walsh, RN
Trauma Coordinator

As I wrote last time, a concussion, also known as a mild traumatic brain injury (MTBI), is caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Quite simply, a concussion alters how the brain normally functions. Concussions can have serious long term health effects and even a subtle “ding” or “bump” can be serious.

According to the Center for Disease Control, it is estimated that nearly 1.6 to 3.8 million sports and recreation concussions occur in the United States each year. Youth 5-18 years of age account for over 2 million sports related emergency room visits per year. Of these visits, nearly 6% or 135,000 involve concussions. Football accounts for nearly 60% of these concussions while bicycling, basketball, soccer and other playground activities round out the top five causes.
If you are a parent or a coach and you believe one of your children or players has suffered a concussion you should:

· Remove the player from the competition immediately.
· Never leave the player alone.
· Get a professional medical evaluation.
· Avoid contact or collision sports for at least 3 weeks.
The 911 system should be activated in the following situations:
· Severe head trauma
· A fall from a height greater than the height of the person
· Prolonged loss of consciousness (greater than 2 minutes)
· Unequal pupils
· Severe Nausea/Vomiting
· Confusion/Perseverating that does not go right away/Restlessness/Agitation
· Extreme drowsiness, weakness or inability to walk
· Severe headache/Slurred speech

A child with a grade III concussion will need to be evaluated by a physician in an emergency setting. A full neurologic exam will be performed to check reflexes, vision, hearing, pupil response, balance, memory, concentration, and coordination. A brain CT scan will be performed to check for any bleeding or bruising in the brain tissue. Admission to the hospital for neurologic observation may also be necessary.

Returning a child to sports after a concussion should be a well defined 4 step process:

1. This should be a gradual process and should be done under the supervision of qualified people. When the player does not have any symptoms, they may be able to do light exercise, stationary cycling or walking.
2. The next step is to do sports specific activity without contact for example running. If there are any symptoms returning then take a step back.
3. Next step is on field practice without contact. Again, any symptoms indicate a return to the previous stage.
4. When a medical doctor has given the go ahead on field practice with contact can begin. The time taken to get to this stage will depend on the severity of the concussion.
Long term consequences of repeated concussions are functional changes that affect thinking, language, emotions, behavior, and sensations. There may be an increased risk of seizure disorders, Alzheimer’s and Parkinson’s disease. Premature return to play can cause permanent neurologic disability from cumulative trauma, death from secondary impact and post concussion syndrome.

Some ways to prevent concussions and their severity are to, wear appropriate headgear at ALL times. Learn proper techniques for tackling opposing players and heading a soccer ball. Understand and recognize the symptoms of a concussion. Never allow an athlete to play if you suspect a concussion. The effects both short and long term are simply not worth it.

The 5 Rights of Dispensing Medication

2008-07-15T10:16:00.000-07:00

By Laura Dillon
Service Coordinator
Saint Francis Home
Care Services, Inc.

Caregivers assume many responsibilities in order to keep their loved ones safe at home. And if you are a caregiver for a loved one at home, chances are that at some time you have had to tackle the task of dealing with your loved one’s medications. This includes calling a prescription into the pharmacy, picking up medications, dispensing medications or helping organize and fill your loved one’s pill box.
If your loved one takes multiple medications, you know that filling a pill box can take extreme concentration and organization. And although it is often a daunting task as several bottles of medication lie before you week after week, let’s remember that medication compliance is extremely important for your loved one’s health and well being.
With that in mind, before giving a loved one any medication, remember to read each medication label to check for the “5 Rights” - Right Person, Right Medication, Right Dose, Right Time, and Right Route. Here is why checking the labels can be so important:

1. Right Person: Make sure that the name on the bottle matches who will be receiving the medication. This step seems self-explanatory and obvious however, if more than one person living in the home takes medications it is easy to mix them up. Often people have a tendency to store all medication in the kitchen as a visual reminder to take the medication either at a meal time or with food. Instead, each resident of the home should have a separate place to store their medications. If pill boxes are used, make sure to clearly label each box with the proper patient name. Do not trust that you will remember a color-coded system.

2. Right Medication: If you are a caregiver to someone who takes more than two medications you know how confusing labels can be. A patient may be taking one medication and suddenly their physician switches them to the generic version. Make sure to ask the physician if you are unsure what the medication is for or if a generic medication was prescribed as a “substitute.” (Hint: To make life easier for yourself as well as medical professionals in case of an emergency, keep an updated list of medications handy and make sure to update it after each doctor’s appointment.) If the physician no longer prescribes a medication to your loved one, discard the old medication and bottle immediately. If it is not discarded, it may accidentally find its way back into your box of medications. Also, do not reuse old, expired medication bottles to store new medication. A healthcare professional would not be able to administer these medications and it may also confuse the patient and caregivers. Additionally, remember that the manufacturers of the medications may change without notice, thus changing its size, shape and/or color. Do not assume what the medication is just by the way it looks! To be safe, keep all medications in their respective bottles unless putting it directly from the bottle into a pill box.

3. Right Dose: Know the correct dose of each medication. A physician may change the dosages of medication at any time, especially medication that has been prescribed for only a short time period or one whose dose depends on how a patient is reacting to it. Stay current on the dosages so as to not over or under medicate your loved one. Do not adjust dose amount without consulting your physician! Although medications can often be costly, “cutting back” on how many pills you take in order to save money can be very dangerous.

4.Right Time: Be sure to know when your loved one should take their medication. Many times there is a reason the medication should be taken at the time specified. The medication may not interact well with food or may cause drowsiness or alertness. If you have concerns about how a medication is affecting your loved one, consult your physician. Do not change medication times prior to a physician consultation.

5. Right Route: Always know how the medication should be taken (orally, inject able, etc.) and follow the instructions properly.
Hopefully the “5 Rights” will help caregivers remember the importance of carefully and correctly reading their loved one’s medication labels. Next time we’ll take a look at alternatives available through Saint Francis Home Care Services, Inc. if a caregiver is no longer able to assist with their loved one’s medications.

Caring for Wounds, Big and Small

2008-07-01T12:15:00.000-07:00

By Frances T. Traver
Clinical Manager

Most of us have cared for some type of wound. You cut your finger, wash it out and put on a Band Aid. However, when you’ve been hospitalized or injured the wounds may be much more complicated and frightening. Despite the size or type of wound, the principles to healing wounds are the same.
There are many different types of wounds. You may have had surgery and need to care for the incision. You may have been bedridden for awhile and had a sore as a result of pressure. You may have burned your hand. All these wounds need some type of care to heal. Whatever the care, the wound needs to be protected from trauma or infection. Your doctor and/or nurse will direct you as to which treatment is best for your wound.
There is a saying that a wound is not a hole in the patient but rather the whole of the patient makes the wound. Your overall condition plays a big role in the healing of any wound. If you have chronic disease, such as diabetes, it will take longer for your wound to heal. A proper diet is important in healing a wound. Certain medications may also slow the healing process of a wound. Your nurse can help you understand your individual condition and discuss how it may be affecting your wound healing.
Here at Saint Francis Hospital, Home Care Services (Certified), Inc. we are blessed to have Helen Bunyi, RN, one of the best wound care nurses working with us. She has recently been recognized as the New York State Nursing Association’s District 19 Clinician of the Year and was honored for nursing excellence by our hospital. But more importantly, our patient’s are always grateful to her. She always seems to know how to heal that wound which just won’t heal.
So don’t be afraid of your wound, there are people to help. You doctor will give you the treatment to best help heal your wound. You need to help heal your wound with good nutrition and chronic disease management.

All About Organic Foods

2008-06-26T13:39:00.000-07:00

By Sarah Daubman, R.D
Staff Dietician

You’ve seen them in the store, heard about them on the news and maybe knowingly, or unknowingly, eaten them at a meal. So what makes foods organic? Are they more nutritious? Should you start (or continue) buying them? Let’s start at the beginning: what exactly is organic?
The National Organic Program (NOP) is a division of the USDA that regulates organic standards, policies and labeling. They define organic as:
Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations. Organic meat, poultry, eggs, and dairy products come from animals that are given no antibiotics or growth hormones. Organic food is produced without using most conventional pesticides; fertilizers made with synthetic ingredients or sewage sludge; bioengineering; or ionizing radiation. Before a product can be labeled "organic," a Government-approved certifier inspects the farm where the food is grown to make sure the farmer is following all the rules necessary to meet USDA organic standards. Companies that handle or process organic food before it gets to your local supermarket or restaurant must be certified, too. (www.ams.usda.gov/NOP)
Organic foods may be labeled in different ways. “One hundred percent Organic” means all ingredients meet or exceed USDA specifications for organic foods, which translates to no synthetic pesticides, herbicides, chemical fertilizers, antibiotics or hormones. Foods labeled “Organic” ensure that 95 percent of ingredients meet or exceed USDA standards and “Made with Organic Ingredients” guarantees 70 percent of the ingredients meet or exceed standards.
Many consumers equate the term organic with pesticide free. However under the guidelines of the NOP, certain quantities of natural pesticides may still be used in organic farming. While natural pesticides do have fewer harmful side effects than synthetic, they are still toxic and therefore organic produce may contain pesticide residue (though lower levels than non-organic produce.) For this reason it is important to wash ALL produce, even those with inedible skins and peels, whether organic or not to ensure optimal pesticide removal.
Even if pesticides are not a concern, there is still the question, “Is organic food more nutritious?” Until recently most research had found no conclusive evidence to support that organic foods were nutritionally superior to conventionally grown foods. However an extensive four year study completed in 2007 by Newcastle University in England found some interesting results. The research concluded that certain fruits and vegetables contained more antioxidants, zinc, iron and vitamin C when grown under organic standards. Despite these new findings, the USDA itself does not make claim to organic foods being more nutritious than non-organic foods.
So should you buy organic? There are arguably endless pros and cons that go beyond the scope of this blog. Believers of the organic movement tout fewer chemicals in their foods and more nutritious produce, not to mention more environment and animal friendly farming and reportedly better “taste.” Others argue that organic foods are too expensive and that quality and stability are reduced due to the lack of conventional fertilizers and preservatives. The fear also exists that the organic trend is merely a marketing ploy set upon unsuspecting consumers. In the end, the ultimate choice regarding eating organic foods is up to you. For more information, check out the following links:
USDA’s National Organic Program: www.ams.usda.gov/NOP
Organic.com www.organic.org/
Article on the Newcastle University study: http://www.medicalnewstoday.com/articles/86972.php

Sports Related Concussions - Part 1

2008-06-12T11:05:00.000-07:00

By Jean M. Walsh, RN
Trauma Coordinator

A concussion, also known as a mild traumatic brain injury (MTBI), is caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Quite simply, a concussion alters how the brain normally functions. Concussions can have serious long term health effects and even a subtle “ding” or “bump” can be serious.
According to the Center for Disease Control, it is estimated that nearly 1.6 to 3.8 million sports and recreation concussions occur in the United States each year. Youth 5-18 years of age account for over 2 million sports related emergency room visits per year. Of these visits, nearly 6% or 135,000 involve concussions. Football accounts for nearly 60% of these concussions while bicycling, basketball, soccer and other playground activities round out the top five causes.
The signs and symptoms of a concussion can be subtle and may not appear immediately. Symptoms can last for days, weeks or longer. The two most common concussion symptoms are confusion and amnesia. The amnesia, which may or may not be preceded by a loss of consciousness, almost always involves the loss of memory of the impact that caused the concussion.
Common symptoms of a concussion may be one or several of the following; headache, blurred vision, dizziness, loss of balance, confusion, amnesia (short term), perseverating (repeating the same thing over and over), ringing in the ears, difficulty concentrating, nausea, vomiting. Symptoms which may occur later are sensitivity to light or sounds, mood changes and sleep disturbances
Concussions are broken down into III grades of severity, with Grade III being the most severe: A Grade I concussion can have some of the symptoms listed above, but with no loss of consciousness and with symptoms ending within 15 minutes. A Grade II concussion, there has been no loss of consciousness but the symptoms last longer than 15 minutes. A Grade III concussion, the person loses consciousness — even if it's just for a few seconds. Knowing the different grades is important because how soon a player can safely return to a sports activity is directly related to the grade of the concussion. With a Grade I concussion, the player can resume play once symptoms have stopped. However, that player should stop play if he or she gets another head injury. A Grade II concussion requires that a player stop playing and not return to any type of sport or physical activity that could cause a head injury for at least another week. This player should be seen by his pediatrician. Someone with a Grade III concussion should see a doctor immediately and not return until medically cleared to do so.
If you are a parent or a coach and you believe one of your children or players has suffered a concussion, what should you do?
More on that next time.

"Home Care" Means Much to Many

2008-06-09T12:08:00.000-07:00

By Laura Dillon
Program Coordinator
Saint Francis Home Care Services, Inc.

Many Hudson Valley residents know that Saint Francis Home Care Services, Inc. has been providing compassionate in-home care assistance to our community for over 20 years. Our patients have received services such as wound care, physical therapy evaluations, cardiac rehabilitation, and the assistance of home health aide visits to the home. But what happens when an individual does not need nursing services or help with their personal care, but instead, they need help with tasks such as: laundry, light homemaking, meal preparation and grocery shopping? For example:

Mrs. S. lives alone. Her children live out of state. She appreciates the help that her neighbors have shown her, but feels that she needs more frequent, consistent help around the house. She can do all her own personal care, but because of her arthritis it is hard to push the vacuum and carry up the laundry basket from downstairs. Additionally, Mrs. S. does not drive and her medications need to be picked up at the pharmacy regularly. Despite these challenges, Mrs. S. wants to continue living in her own home.

To meet the needs of clients who want to stay safely at home as long as possible we have created the “Care-Givers at your Service” program which focuses solely on assisting with non-medical tasks. This non-medical care provides clients with services such as:

· companionship & friendly visitor services
· shopping & errand services
· meal preparation, baking & clean-up
· laundry/ironing services
· homemaking/housekeeping
· attend social/recreational activity
· monitor diet, eating & food expirations
· care of house plants & simple gardening
· medication reminders
· arranging medical appointments
· escort/reminders to appointments
· oversee home maintenance
· assistance with mail & paying bills
· accompany on vacations
· assistance with walking
· assist with pet care

Mrs. S. would benefit greatly from this program. Should her care ever require more medical attention, services can easily transition to our Licensed Home Care Program where nursing and certified Home Health Aide services provide more medical oversight and hands-on care.

For more information about the “Care-Givers at Your Service” program please contact Laura at 845-483-5528 or ldillon@sfhhc.org

Dealing With Medication Issues

2008-05-29T06:50:00.000-07:00

By Frances H. Traver
Manager, Clinical Services

There are more than three million older adults in the United States. Many need to take medication every day in order to stay healthy. A majority of these older adults take an average of three-to-five different medications daily. It is often difficult for these older adults to take these medications as ordered. I have difficulty remembering to take my vitamins, I don’t know how they remember to take all their medications.

Studies show that up to 59 percent of the elderly have difficulty with taking medications correctly. The consequence of not doing so can be devastating and may lead to falls, hospitalization and/or nursing home placement.

There are many reasons an elderly person may have difficulty taking all their medications. The first may be the number or type of medical conditions, such as heart problems or depression. These conditions may cause the elderly person to be more forgetful. Other medical conditions may affect a person’s vision.

How can a caregiver be assured their elderly family member is taking all their needed medications? I have found it best to ask how they take their medications in a non-threatening manner and not “if they take their medications.” They will often say they are taking their medications but really having difficulties.

Our goal at Saint Francis Home Care is to help our patients help themselves. Home care nurses will ask the elderly patient to read the medication bottle label to them, assuring that the elderly can read the label correctly and understand what it means. In order to help these patients, the nurses and/or occupational therapists at Saint Francis Home Health services can work with you and your elderly family member who may be having trouble. Our agency has been able to improve the majority of our patient’s ability to manage their own medications.

When you compare our outcomes in medication management to other agencies throughout the country, we are about 20 percent higher.

A Tribute To Nurses

2008-05-20T12:28:00.000-07:00

By Susan Hecht, RN
Nursing Rehabilitation Liaison

I would like to take some time and reflect back on Nurses Week and what it means to me as well as National Hospital Week. I was an LPN of six years when I first came to Saint Francis Hospital. I was hired for the Comprehensive Integrated Inpatient Rehabilitation Unit. Just starting in a hospital setting, I was very nervous and apprehensive. The nursing staff at Saint Francis oriented me and "took me under their wings" to teach me many new things.

It has been nine years now and I remain on the same unit as the Nursing Rehabilitation Liaison. I enjoyed being an LPN and continued on with the encouragement from the staff to obtain my RN (which I have had now for three years). I am also presently going to SUNY New Paltz for my BSN. Nursing is a wonderful career that has so many opportunities. The avenues in the nursing profession are endless.

Nurses are compassionate professional caregivers providing care to patients and families in the hospital as well as the community. Saint Francis has helped me and many others grow in our professions; allowing us opportunity to return to school to further our education, to encourage us to participate in hospital committees and be a part of the organization. I have learned many things from my peers and will continue to do so. Nursing can lead you down many paths: education, clinical, management, home care and so many more.

Saint Francis Hospital honors not only the National Hospital Week in May but honors their employees the entire month. Everyone wants recognition for the jobs they do and Saint Francis Hospital takes the time to do that. Some of the ways we have found to do this is: dedicate a day to say thank you to the volunteers that give their time; nursing recognition breakfasts are held at different sites; and the Sister Ann Elizabeth Nursing Excellence Award is presented (this is one of my favorites because you get to nominate your peers for the excellent job they do everyday). Hats off to Helen Bunyi from our Home Care Services for winning this year’s Sister Ann Elizabeth Nursing Excellence Award!

There are many days throughout the month recognizing different departments; but most of all to say thank you for all you do at Saint Francis. Saint Francis exemplifies their employees through their CREST of Values, Compassionate Care, Respect, Excellence, Service and Teamwork.Saint Francis is a team with everyone working together to give excellent health care to the community. We offer many services, Trauma and Emergency Room Care, Cancer Center, Joint Replacement Center, Spine Programs, Inpatient Acute Rehabilitation, Stroke Center, Physical and Occupational Services for inpatients and outpatients, Center for Communication Disorders, Blood Conservation Programs, Diabetes Programs, Diagnostic Imaging Services, Sleep Center, Behavioral Health, Cardiac Catheterization, Bariatric Services and so many more.

This month especially makes me proud to not only be a professional registered nurse but also to be a part of Saint Francis Hospital. We all remember back in our careers at some point or another those who have mentored, molded and shaped us in one way or another. I would like to take the time to say thank you to a few that have made a difference in my professional nursing career, Pat Nocket (Director/Patient Care Services), Pat Churna (Coordinator/Home Care Services), Carla Richardson (Business Coordinator), Suzanne McLaughlin (CNO), Jackie Ragone (ICU/RN) and Lousiemary Witcher-Schoonmaker (Education) and to Saint Francis Hospital for allowing myself and many others the opportunity to grow in our professions. To all nurses; Happy Nurses Week and hats off to Saint Francis Hospital and all others for National Hospital Week.

Think Home, Think Safety

2008-04-21T12:07:00.001-07:00

By Laura Dillon
Program Coordinator
Saint Francis Home Care Services, Inc.

On average, one out of every three adults over the age of 65 falls each year. With this statistic, it is no wonder that for many, the mere thought of falling and hurting themselves can be scary and stressful. Even the most active seniors can feel inhibited enough by this fear that they hesitate to meet friends for lunch or even walk to the mailbox. The thought of having to leave our own home for a stay at a rehabilitation facility or nursing home is often unbearable.
With this in mind, we try our best to ensure our safety when we leave the home (bringing our walking aides, wearing proper footwear, etc.) On the other hand, we often either overlook the potential safety hazards within our own homes, or think “I have no time to change that.” But as Spring arrives, so does a chance to do some spring cleaning. This may be just the time to reevaluate how safe our homes really are, and to make changes if necessary. Whether you are a senior, a caregiver, or both, here are some tips on how to create a safer home for you or your loved one:

Have adequate lighting when walking through rooms or hallways and when going up and down stairs. Use a night light in the bedroom and bathroom.
Remove scatter rugs and/or use slip resistant rugs.
Repair, replace or remove worn carpeting.
Keep frequently used items on shelves or in cabinets at waist level. Use a reacher for high or low items.
Sit at the bedside a few minutes before standing. Stand at bedside a while before walking.
Keep pathways clear. Remove low-lying objects from walkway including extension cords and telephone wires.
Use a bedside commode if walking to the bathroom is difficult, especially during the night. Use a tub seat and/or install tub/shower grab bars in bathing areas for better stability.
Use stable chairs with armrests for seating.
Use non-skid strips or rubber mats in the bottom of the tub.
Use well fitting close-back shoes/slippers with non-skid soles.
Use walking aide as instructed.
Do not overload electrical outlets. Do not use cords which are cracked or frayed.
Wear glasses and hearing aids if necessary.

No matter how hard we try, however, accidents do happen. If an accident or fall does occur, then it is beneficial for your loved one to have either a cordless phone with emergency telephone numbers easily accessible, or a Lifeline (personal emergency response system) with them at all times. Wearing a Lifeline is a good safety precaution to take, even in the safest of homes. For a free consultation on how Lifeline could help you or someone you love stay safe at home, contact Laura at Saint Francis Home Care Services, Inc. at 845-483-5528 or ldillon@sfhhc.org. Remember, Saint Francis Home Care Services, Inc. is here to help.

Making Sense of Food Labels

2008-03-28T11:02:00.000-07:00

By Joanne Chaconis, RD
Chief Clinical Dietician

Food labels are a great idea, right? They’re like windows on the products we buy. Despite the fact that they are under the watch of either the U.S. Food and Drug Administration or the U.S. Department of Agriculture, some of the wording can make food labels difficult to decipher. Here are some guidelines adapted from an article in the March edition of “Real Simple” magazine.

Heart Healthy: These foods are low in saturated fats, low in cholesterol, and low in sodium. They also have no trans fats. It also means they contain three or less grams of fat per serving and have at least 0.6 gram of soluble fiber.

0 grams trans fat: Contains less than 0.5 gram of fat per serving. Light means the food has up to 50 percent less fat than the counterpart.

Fat-free: This product contains less than 0.5 gram of fat per serving. Most adults should aim for 2,300 milligrams or less per day. Try to choose foods with fewer milligrams of sodium than calories.

Low-carb: There are no standards for this term. Remember that whole grains and fresh fruit and veggies are healthy carbs. The low-carb term does not distinguish between “good, healthy” carbs and “refined” carbs like sugar.

Sugar-free: The serving contains less than 0.5 gram of sugar. Sugar free doesn’t always mean low calorie as these products are sometimes laced with sugar alcohols or starch.

Gluten-free: This product contains no gluten, which is a wheat protein. A gluten-free product means no wheat, but a product labeled wheat-free doesn’t mean it’s gluten-free. Check also for rye, barley, malt, and malt extracts (oats can also be an offensive item to someone who is gluten intolerant.)

Organic: Foods are made without potentially harmful pesticides, fertilizers, antibiotics, synthetic hormones or genetic engineering. It also means the product contains at least 95 percent organic ingredients.

100 percent natural: These products do not contain artificial flavors, colors or preservatives. They can still be abundant with sugar, fat or calories, however.

Light: Most of the time this means the product contains a third less calories than the full calorie counterpart. If referring to sodium or fat, it means up to 50 percent less.

No antiobiotics: Found on the labels of red meat, poultry and milk. This means the animals were raised without being fed antibiotics.

No hormones: Found on the labels of beef and dairy. This means the animals were not given hormones. The hormones are usually added to make the animals gain weight or produce milk quicker.

Happy shopping!

Care for the Caregiver

2008-03-04T12:23:00.000-08:00

By Dana Pavelock, Dir.,
Home Care Operations

Roughly 25 percent of families are relying on informal family caregivers to bridge the needs of caring for a loved one at home. Today, 30 million households are providing care for an adult over the age of 50 and this number is expected to double over the next 25 years. This informal and highly motivated workforce of caregivers often find themselves struggling to navigate a very complex system of health care and are under a great deal of stress.
Informal caregivers tend to be family members, mostly women between ages 45 and 65, attempting to balance the needs of parents and grandparents with children and grandchildren. Often these individuals find themselves suddenly immersed in the role of caregiver without warning, preparation and/or training and are at risk of compromising their own health care and social needs. Rarely is there a support system for them.
As the aging population continues to grow at a very fast rate there will be more and more demands placed upon family caregivers. Combined also with a higher life expectancy and with the trend for the aging population to want to remain at home, we will need ongoing support from local and county government and private agencies.
Some of you may not be in a care-giving role at this time. While you might not be thinking about it now, being proactive and establishing a plan in anticipation you will soon be launched into caring for a family member may help avoid some of the stress and other tensions that materialize at work and at home.
The first step is a conversation with the person you expect will require more care and support to live safely at home, identifying potential support and services that are readily available, anticipating care needs and establishing a plan. All too often, one person takes on the primary role as caregiver which often leads to physical and emotional exhaustion and can result in development of increased health risks to the caregiver.
Fortunately there is help available for individuals who find themselves suddenly in that care-giving role. The best resource is to start by contacting your count’s Office for the Aging, surfing the Internet and reaching out to home care agencies. There is a wealth of information that will provide you with the necessary tools and support you may need so that you can take good care of a loved one and, at the same time, help maintain your own quality of life.
As you might expect, it takes a very special person to fulfill the role of caregiver. In our particular agency, we have long recognized the value of both paid and unpaid family caregivers, recently obtaining a grant through the Dutchess County Office of the Aging to lead a Caregiver Support, Training and Counseling program that provides various workshops, trainings and even an employee to provide one-on-one visitation in the home, free of charge for caregivers.
When it comes to paid caregivers, please do not underestimate their genuine concern and passion for what it is they do every day.
Relationships that are formed between patients and our caregivers is priceless and can be captured by quoting a few words taken from something written by Home Health Aide Sharon Greene: “I am a health care worker, I enjoy my job and this is what I do best. Put a smile on someone’s face, making their day and just being there for them.”

Wii System More Than A Game

2008-02-22T06:10:00.001-08:00

By Susan Hecht, R.N.

Video games, for many years that I can remember, have been geared to the younger generation with parents complaining, “Those video games are no good,” and “My kids sit in front of the television all day on those games.” The older generation often describes video systems as, “Too complicated!” “They’re for kids” or “They’re no good for you.”

But the new Nintendo Wii system is playing a big part in rehabilitation for stroke, brain injury and other patients with decrease in balance, coordination or functional mobility.

Wii requires the player to perform the movements of the game as opposed to pushing buttons on a controller. Saint Francis Hospital’s Comprehensive Integrated Inpatient Rehabilitation Program has implemented the Wii system.

I personally have played the game. It is unbelievable, great for exercise, coordination, balance, eye-hand coordination and motor skills. Here’s how it helps a patient:

It is much more fun than the traditional therapies and exercise programs. It assists in getting patients to communicate and participate in group activities. It helps gain coordination and balance. The games simulate activities such as; tennis, golf, bowling, racing, Ninja games and many more. Keep in mind different games may be helpful to different patients depending on their diagnosis. The games resemble movements of activities of daily living, such as sweeping, washing windows or sometimes even the sport itself. The Ninja games help patients with eye-hand coordination and to even improve scanning visual fields.

Keep in mind that the Wii system is just a tool used by the patients with staff monitoring and does not replace the individual therapy designed upon admission. Here’s some feedback from patients who have used the system: “It was great, the golf is very realistic, and I am a big golfer. It was very helpful” and “The bowling was good for me; it showed me my weaknesses and what I need to work on.”

Saint Francis Hospital Inpatient Rehab continues to research innovative ways to improve the quality of life and increase independence to all our patients throughout their rehabilitation stay.

Muscle Loss Part of Aging Process

2008-02-18T11:58:00.000-08:00

By Joanne Chaconis, RD
Chief Clinical Dietician

I recently read an article that caught my eye because it applies to an age group that I find myself a member 44 -55 years. It addressed a condition called sarcopenia. This means a degree of muscle loss (suddenly gray hairs don’t seem so bad!). But even though skeletal muscle starts to decline in this age group, there are ways to lessen the impact.

1.) Less muscle, less bone. It seems that osteoporosis and sarcopenia are interrelated. If you lose muscle, you lose bone because muscle helps prevent bone loss. Therefore, weight-bearing exercises are recommended.

2.) Muscle helps to control blood sugar. As muscle mass decreases, it alters the body’s ability to keep blood sugars stable. That means your risk of developing type 2 diabetes increases.

3.) Ensure adequate protein intake. Research is finding that a low protein intake contributes to muscle loss. About 50 grams of protein is recommended daily. High quality protein sources are lean meats, fish, low fat dairy, and eggs. Non-animal sources to consider are dried beans, legumes, lentils, and tofu.

4.) Stay active. Activity helps to increase and maintain muscle strength. Studies show that people in their 70s, 80s, and even 90s benefit from safe strength training.

So, adopting these principles to make some changes, or continuing with an already health lifestyle, can help as the aging process marches on.

Physical Therapy Services At Home

2008-02-14T07:54:00.000-08:00

By Dana Pavelock, Dir., Home Care Operations

In today’s ever changing world, combined with significant aging trends, shorter hospital and skilled nursing facility stays, the demand for physical therapy is ever increasing. In fact, state and national averages along with Saint Francis Hospital Certified Home Health Services statistics reflect that 68 percent to 73 percent of all patients receive in-home care physical therapy services. In-home physical therapy is ideal for many patients and has been an option available in the health care field for many years. I’ll attempt to provide some education as to what types of services at home Physical Therapists perform, determining what patients may qualify for In-Home Therapy and how to access services and choose the right provider.

The starting point with most home care services, including Physical Therapy, generally begins with obtaining an order from your treating physician or contacting a home care agency and presenting your circumstances to an intake worker that will help you navigate the system. Those recovering from any type of musculoskeletal problems, suffering from neurological conditions like Cerebral Vascular disease (stroke), Multiple Sclerosis (MS), Parkinson’s disease or recovering from orthopedic surgery like knee or hip replacement, are very commonly served by arranging physical therapy at home.
Most agencies will consult with the physician and obtain a script for an assessment to be completed. One of the primary criteria to receive in-home rehabilitative therapy is the patient must be considered “homebound,” requiring assistance to get in or out of the house due to some muscle weakness, decreased balance or endurance, and difficulty walking due to some musculoskeletal or neurological deficits. Patient evaluation may include measurement of range of motion, strength, balance, safety awareness, and level of assistance required in determining intervention outcomes.

A home safety evaluation will review various safety hazards such as loose rugs/carpeting, evaluate the home environment for needed modifications to make living space more accessible with assistive devices and durable medical equipment such as raised toilet seats, tub/shower chairs, transfer and lift devices, walkers or wheelchairs, grab bars and personal emergency response systems. The evaluation will incorporate procedures and techniques in determining one’s ability to perform at his or her optimal level: Based on one’s prior, versus current, level of functioning, physical therapy intervention is valuable in achieving improvement in future quality of life.

Once an assessment is completed a physical therapist will create a comprehensive plan of care in collaboration with your treating physician and other caregivers with the end goal helping achieve your highest functional mobility if not to bring you back to your prior level of functioning before your illness. Physical therapy services focus on therapeutic exercise programs, activity training like transfers and bed mobility, neuromuscular re-education to work on balance and muscle strengthening, gait training and pain management. Safety training is of primary concern to make sure that during your recovery period secondary complications from falling will be avoided. Generally, Medicare long term or private insurance will also authorize a Home Health Aide, oriented by the treating therapist, to assist the patient with their therapeutic exercise program.

Special thanks to Phil Ricafort, Physical Therapy Supervisor with Saint Francis Hospital Certified Home Health Services, (845-483-5550), an expert in the field, who contributed to this information. According to Ricafort, one of the most important actions one should take in choosing an agency is to review credentialing, insuring the agency is certified by the state Department of Health and Joint Commission accredited. Another important factor is to review quality outcome measures of the agency you are considering to obtain services from that can be accessed by visiting http://www.medicare.gov/.

Spreading the Word About Rehab Unit

2008-01-28T06:35:00.000-08:00

By Susan Hecht, R.N.

I am employed by Saint Francis Hospital and Health Centers as the Rehabilitation Nursing Liaison for the Comprehensive Integrated Rehabilitation Program and recently I’ve been out in the community speaking with patients and their families about the services we offer on our Rehab Unit.

Some were surprised to hear the variety of services we offer, but others know all about us, as you can see through such comments as:

“I want to send special thanks to everyone who took such special care of me at Saint Francis Hospital”… “Saint Francis Rehab was great – showing me the things I needed to be able to care for myself at home”…“Everyone is wonderful. They were always there when you needed them.”

“The staff on the Rehabilitation Unit is wonderful. The caring, expert staff provided excellent care and taught me how to get back on my feet and begin my recovery”… “I wish to express a heartfelt appreciation for the kindness and excellent care I received. The sensitivity and support of your fine staff 24 hours a day, 7 days a week helped us through what was a difficult time following my surgery.”

And, “Express our appreciation to the staff for going ABOVE and BEYOND the call of duty everyday.”

The Rehabilitation Center at Saint Francis Hospital started in 1978. It was the first hospital rehab facility serving patients 18 and older between Albany and New York City. Our patients come from all over the mid-Hudson Region to our 26 bed facility, accredited by the Commission on Accreditation of Rehabilitation Facilities.

Patients served include, but are not limited to, stroke, major multiple trauma, neurological disorders, polyarthritis, fracture of femur, spinal cord injuries, bilateral joint replacement, and brain injury.

Among the services offered are: 24-hour nursing care, staff physiatrist, physical therapy, occupational therapy, speech therapy, pet therapy, rehab neuropsychology, and social work.

Saint Francis Hospital’s success in providing an exceptional rehabilitation program is critical to improving quality of life and returning patients to the home setting. In fact, last year 85 percent of our patients returned home after treatment. We’re proud of the work we do and are pleased to share this information with you.

For more information feel free to call me at 845-483-5164.

Technological Advancements in Home Care

2008-01-24T11:10:00.000-08:00

By Dana Pavelock,
Dir., Home Care Operations

One of the most challenging issues faced by the aging population and family caregivers is how to insure they are safe at home alone or when 24-hour home care or live-in services may not be a viable option. Thanks to technological advancements there are many excellent products available geared toward electronically managing one’s health, insuring medications are taken properly as ordered by the physician and emergency alert systems that provide the necessary measures to promote independence while at the same time providing peace of mind for family members or caregivers.

Imagine the peace of mind provided to a family caregiver when told that we have the technology allowing us to monitor patient care 7 days a week by use of a tele-monitoring service. Imagine the sense of security to the patient or family member when we can demonstrate that in many cases, use of tele-monitoring reduces re-hospitalizations and emergency room visits anywhere from 40 percent to75 percent. Imagine the sense of independence and privacy one can continue to enjoy by use of this easy-to-use technology.

Basic tele-monitoring programs involve placement of very sophisticated FDA-approved monitoring devices in the home (by doctor’s order) that patients are easily trained to use. Within 4 minutes, a basic monitoring device can check weight, blood pressure, heart rates and blood oxygen levels and automatically transmits that information to a tele-health nurse who reviews the reports and responds accordingly. In cases where the test results are beyond the parameters set by the doctor, the nurse will provide an intervention, sometimes as simple as contacting a doctor and facilitating a medication change or, perhaps scheduling a nursing visit for further assessment. More sophisticated devices are capable of adding peripherals to monitor glucose, peak flow, PT/INR, ECG and temperature. Some Medicare-certified home care agencies offer this service free of charges as part of their overall care plan. Licensed agencies may offer private pay models focusing more on a wellness model.

Having difficulty managing those medications? Tired of filling those pillboxes only to find that there are continuous issues of under or over medicating happening in the home? Nearly 30 percent of hospital admissions, 40 percent of skilled nursing home placements, and approximately 125,000 deaths occur each year because patients are unable to manage their medications at home. Fortunately, new technology has been revolutionizing ways to effectively manage and monitor medication compliance in the home setting.

Our preference, the MD-2 Personal Medication System is a viable solution for individuals who have trouble remembering, organizing or taking their medications. The system works well for individuals who experience forgetfulness or who may be likely to take too much, too little or perhaps even the wrong medication. This device simplifies medication organization and delivery so that oral medication dosages will be taken on-time and as prescribed. The unit can hold up to 60 doses of medication (each dose holding up to 25 pills), can be programmed to deliver up to 6 doses per day and uses voice, tone and flashing lights to remind the patient to take their medication. When medication schedules are twice daily, the system can store a 30 day supply of medications. It also can be programmed to give specific verbal and text reminders to take or apply non-oral medications, to take with food etc. In the event the individual doesn’t respond to the prompt, after an hour and a half of reminders every minute, the unit will automatically shift the missed dose to a storage chamber in the unit and alert up to four caregivers that the user has missed a dose. Lastly, the monitoring service notifies caregivers when medications are running low and needs to be refilled.

Personal Emergency Response Systems (PERS) have been around for years and probably the most popular systems used in the home, but in my opinion under-utilized. These units are also attached to the home phone line and by use of a panic button (often set up on a pendant or wrist bracelet) which when pressed dials an emergency response center that first calls the home to verify the emergency and then dispatches emergency responders. At minimum, I would suggest anyone living at home alone that is frail, has an unsteady gait or is at risk of falls seriously consider a PERS system. The cost is usually just a little more than $1 a day. Most devices now have a 2-way voice feature allowing a patient to communicate even when they are far from the unit.

We have only begun to see the very beginning of a very exciting time with regard to all the new technology that will be continued to be developed allowing our ever-growing aging population to remain living safely at home, empower people to manage their own care, improve overall quality of life and give them the therapeutic advantages of better health and well-being while promoting more independence. There are different products available and various agencies that offer some or all of these new technology devices. Contacting your local Office for the Aging is a good first step.

A Trauma Surgeon's New Year Wishes

2008-01-22T12:38:00.000-08:00

By Cynthia Leslie, MD, FACS
Director, Trauma Services

A lot of people make resolutions for the New Year, but very few of us keep them. This year I’d like to do something different by making wishes, and hopefully resolutions, for the many people who I do not want to treat as traumatically injured patients at Saint Francis Hospital’s Trauma Center. My hope is that a shared awareness of the devastation of traumatic injury will motivate all of us to do something to end the ongoing cycle of injury and death.
Let’s resolve to:

1.) Not run yellow and red lights
2.) Be more aware of the vulnerability of the many pedestrians who share our streets and roadways
3.) Slow down and respect the rights of other drivers
4.) Put down our cell phones and drive with two hands and a dedicated brain
5.) Never attempt to text message while driving
6.) Stop driving cars as though they were Nintendo games
7.) Stop the cycle of elderly car crashes by driving senior citizens to where they need to go
8.) Check on elderly neighbors regularly and often
9.) Stop drinking and driving
10.) Buckle up every single time – even in the back seat
11.) Always use a designated driver
12.) Drive with our brains and not our hormones
13.) Stop the road rage
14.) Drive defensively
15.) Think critically
16.) Stop the stupidity
17.) Temper the anger
18.) Enjoy the moment
19.) Remember that everything you do affects someone else for good or bad
20.) Always respect and protect women and children
21.) Do unto others as you would have others do unto you
22.) Tell your loved ones how much you love them, regularly and often
23.) Live as well as you can and as fully as you can because life is short and
24.) Remember that Death Is Forever.

These are my wishes for the New Year. Peace, love and safety to you and yours.
Sincerely,

Cynthia Leslie MD
Director of Trauma
Saint Francis Hospital
Poughkeepsie, NY

Break the Fast and Eat Breakfast

2008-01-17T09:50:00.001-08:00

By Sarah Daubman, RD
Staff Dietician

I heard in the news recently that January is “Resolve to Eat Breakfast Month.” Working in the dietetics field, I often have patients, friends and family admit to me that they do not eat breakfast. The most popular excuse is that they don’t have time. Others mistakenly think that skipping breakfast will help with weight loss goals.

It appears that they are not alone, however, given that someone decided to dedicate the whole month of January to improving our morning meal.

General Mills, a company whose business is breakfast, surveyed a group and found that only 48 percent of those aged 25-54 report eating breakfast every day. Children aged 6-11 did better, as 76 percent of those questioned ate daily breakfast.

In my opinion, breakfast IS the most important meal of the day.

Contrary to belief, eating breakfast can actually help people lose weight and keep it off. When you skip breakfast, aren’t you “starving” by lunch time? If you are like me, I’m often tempted to eat the first food I see when I am very hungry. Eating breakfast is a means to prevent you from making poor food choices and overeating later in the day.

Not convinced? Consider this: When you skip breakfast your body thinks you are fasting, thereby conserving energy and lowering your metabolism until you eat again. This means you are burning fewer calories and weight loss is less likely. Encouraging children to eat breakfast is just as important. Like adults, children who eat breakfast are less likely to be overweight. Additionally, they perform better at school and are less likely to be tardy or absent.

So, what’s the ideal breakfast? Your best breakfast will include a whole grain, a lean protein choice (such as low fat dairy, soymilk, egg whites or substitutes or a lean meat), fruit and, if desired, a serving of a healthy fat. An example would be whole wheat toast with peanut butter, half a banana and a cup of 1 percent milk.

Encourage your children to east breakfast by setting a good example. Kids may enjoy low fat chocolate milk boxes, fruit cups, open face peanut butter sandwiches with raisins or apples, or yogurt smoothies. Want to see how your breakfast adds up? Check out the Breakfast Calculator at www.breakfastresearchinsitute.org and happy eating.

Home Care Nurses Wear Many Hats

2008-01-11T11:53:00.000-08:00

By Dana Pavelock
Director of Home Care Operations

It seems like every week our agency receives calls and letter praising the care provided by our nursing staff. Our Medicare Certified Home Health Agency (CHHA) maintains an active census of approximately 350 patients. Over the years, meeting their needs has become more complex as new technology and medical equipment make it possible for people to remain at home rather than in skilled nursing facilities. Let’s face it – very few people actually plan for accessing home care services but when suddenly faced with a significant medical issue that justifies these services nearly 100 percent of all patients served in home care are most satisfied with the services they received.
Granted, accessing that service when it is paid for through Medicare, Medicaid or commercial insurance makes the service that much more value added, but the real reason the experience is so positive is largely due to the nurses that deliver the care. In fact, many patients and family members clearly recognize the value of this service and often choose to continue to pay for private home care services long after Medicare or insurance is no longer willing to pay.
Nurses who work for a CHHA certainly wear many, many hats. They may be handling intake calls and initial home care assessments in addition to visiting their scheduled patients. Their skilled nursing includes cardiac and general systems assessment, wound care, medication management and significant patient and family teaching on how to manage new diagnoses. Supervision of the aides is part of their day as well, with other free time spent driving, working behind the scenes providing case management services, coordinating patient care and preparation for discharge. Last, but not least – there continues to be a lot of paperwork required by our regulatory bodies such as the state Department of Health. Obviously, individuals enter the field of nursing due to their desire to be nurturing skilled caregivers and to improve quality of life to whomever they serve. Fortunately for those that currently need home care services, these nurses have an untiring commitment to providing exceptional skilled care, great customer service and are able to provide care to throughout all areas of Dutchess County.
CHHA nursing services vary from agency to agency, each usually offering certain areas of specialized skilled nursing care and programs. For example, our agency is well known for the specialists we employ that provide ostomy, wound, cancer and psychiatric home care. Additionally, our nurses with specialized cardiac care training manage patient’s health daily via a combination of routine home care visits and through use of computerized Tele-Health Monitoring.
The starting point in accessing services from a CHHA is generally with obtaining an order from your treating physician or contacting the home care agency directly and presenting your circumstances to an intake worker who will help you navigate through the system. Most agencies will consult with the physician and obtain a script for an assessment to be completed. One of the primary criteria to receive in-home skilled nursing care the patient must be considered “homebound,” requiring assistance to be able to get in or out of the house due to a medical condition (decreased balance, endurance and difficulty walking do to some musculoskeletal or neurological deficits etc.)
The patient assessment is very comprehensive and a home safety evaluation will review various safety hazards to insure that the care needs can be delivered. Once an assessment is completed a nurse will create a plan of care in collaboration with your treating physician and other caregivers with the end goal helping bring you back to your prior level of functioning before your illness. Generally Medicare and some long term or private insurance will also authorize a Home Health Aide as an extension of the skilled services being provided. Aides are oriented and supervised by the nurse, to assist the patient with their personal care needs and/or exercise programs.

Dietary Fiber and Heart Disease

2008-01-03T11:40:00.000-08:00

By Joanne Chaconis, RD
Chief Clinical Dietician

The ribbon cutting ceremony for our Charles and Mabel E. Conklin Diagnostic Cardiac Catheterization Laboratory takes place Jan. 4 and I thought that this blog would be timely.

Of course the right type and amount of fat plays an important preventive role in heart disease, as well, and that topic will be addressed separately at another time.

Fiber may not always come to mind when one thinks of the fight against heart disease. However; fiber, the part of plant foods that cannot be digested by the body, can help prevent heart disease in the following ways:

1.) Lower high blood cholesterol. The fiber in beans, oats and barley can help to lower serum cholesterol in some people.

2.) Lower blood pressure. Research shows that high fiber foods can help lower blood pressure because these foods are often lower in fat and calories. Blood pressure rises when arteries become clogged due to high blood cholesterol.

3.) Prevents obesity. Fiber rich foods make you feel fuller sooner so that you eat less. Plus, the added bulk makes you feel fuller longer.

An adequate daily amount of fiber is 25-35 grams per day. Here are some tips to insure an adequate intake:

* Eat at least 2 cups of fresh fruits and 2 1/2 cups of fresh vegetables daily.

* Add thawed, frozen vegetables to soups, pasta and sauces.

* Serve your lean meats, poultry or fish over steamed vegetables.

* When ordering pizza, select vegetables such as broccoli or green peppers for toppings.

* Snack on whole grain cereal and dry roasted nuts.

If you have not been used to eating an adequate amount of fiber in your diet, slowly introduce more on a daily basis. Eating too much at one time can result in abdominal discomfort (to put it mildly ! ) .

More info can be found by logging onto www.nationalfibercouncil.org

What Service Is Appropriate?

2007-12-19T06:43:00.000-08:00

By Dana Pavelock, Director of Home Care Operations

With the significant aging trend of the U.S. population, many of us soon will be grappling with serious decisions with care and assistance for our elderly parents, relatives or even ourselves. I welcome the opportunity to sort out and address the complexities of the home health care industry. I hope to provide valuable information to assist you in making informed decisions for accessing services for yourselves or a loved one.

As you may already be aware, home health care is the fastest growing industry nationally. The service is most appropriate for those individuals that require a variety of skilled nursing or therapy and/or paraprofessional support. For some, that may mean short term care if recuperating from a recent hospitalization, injury or illness. For others, it may mean making arrangements for long-term care needs or extended hours of care. In all cases, and especially when in doubt about what level of care is needed, it is important to consult with the treating physician. One of the greatest benefits of this industry growth for all of us is that there are many choices and more options for elder care that never existed before. The home care industry offers a great alternative to institutional placement and the opportunity to remain living safely in the privacy of our homes and function as independently as possible for as long as we may choose.

Given our own agency experience there has been a significant request for live-in caregivers. Up until the past few years a majority of home care needs have been delivered on an hourly basis. Hourly home health aide services certainly make sense when an individual might need some basic help with personal care (morning or evening care, assistance with bathing, dressing, grooming, meal preparation, medications etc.) and for the most part still are relatively independent. When an individual’s health needs become more complex or are at significant risk for falls, when memory impairments or increased frailness occur, more hours of care may be required so that they can live safely at home. Up until the past decade, many people requiring more significant care at home were either cared for by immediate family members or placed in nursing homes.

The decision of when or why to switch from hourly to live-in services is very individual in nature and often a decision made by family members and/or the patient. We recommend live-in care when a patient’s care needs exceed 8 to 10 hours of care daily and for those desiring to remain at home vs. placement in skilled nursing care or other institutional facilities.

The benefits of accessing live-in aide:
· Cost savings: more affordable than hourly care or skilled nursing facilities.
· Continuity: one aide to provide care vs. two or three staff.
· Consistency: reliability of consistent coverage without interruption.
· Quality: Live-in caregivers dedicate their lives to provide excellent patient care
· Living at home

How does one make arrangements in finding a live-in aide? Accessing this level of service may be easier than you think. In fact, in some cases it might be easier for an agency to place a live-in caregiver than arranging hourly coverage. Also, it is important to note that this service may be appropriate for short term or respite care as well. In choosing an agency consider the following. Is the agency licensed by the state Dept. of Health? Accredited by JCAHO? Insured?
· How long has the agency been providing live-in care service?
· Does the agency conduct thorough criminal background checks and drug screens?
· What type of nursing oversight is provided to the patient and the aide?
· The level of training, experience and skills of the aide.
· Can the agency accept long-term insurance (if applicable).
· Reputation of the agency? Ask around, check the Better Business Bureau.

One last thing to consider. Please remember that when making arrangements for the care of a loved one at home that the cost associated with the delivery of care should not be the primary reason for making your decision. Also remember that you are purchasing more than just the hours the aide provides, you are entering into a relationship with a service agency to provide the best care and oversight possible so that the person receiving the care can remain living at home with dignity and respect!

DVT Learning Experience

2007-12-07T08:23:00.000-08:00

By Susan Hecht, R.N.

A Deep Vein Thrombosis (DVT) is a blood clot that forms in a deep vein, usually in the leg. It is possible for this clot to break away and travel throughout the body to vital organs causing severe damage. Some of the risk factors for DVT are surgery, hereditary blood-clotting disorders, increasing age, hospitalization, and prolonged sitting – like when you drive or fly long distances.

American Airlines, among others airlines, has recognized this prolonged sitting risk factor. They are presently educating their passengers prior to departures. They go on to explain in their airline magazine, “American Way,” what a DVT is, the risk factors, possible symptoms, ways to reduce risk and, most importantly, In-Flight Exercises that can be done to continue to keep the blood circulating during long flights and prolonged sitting.

Some of these exercises are ankle circles, foot pumps, knee lifts, and knee to chest exercises. It is very pleasing to see that the awareness and education of DVT is being presented to the community. Several months ago, Saint Francis Hospital presented a free community seminar on the topic. Our speaker was Melanie Bloom, whose husband, NBC News Correspondent David Bloom, died from DVT complications.

Educating people regarding health issues is the first step to prevention. Recently, Arizona Diamondbacks player Chad Tracy had knee surgery. Not knowing the risk factors, he was already at risk for DVT related to the surgery, but he then traveled from his home in North Carolina home to Phoenix to have his knee examined by team doctors.

After flying home he began to experience calf pain that “he didn’t think much about” because he thought it was related to the surgery. This pain became more intense and he went to a hospital emergency room.

“The doctors think the flight brought it out,” Tracy topld the Associated Press. “Some people get clots from flying – deep vein thrombosis they call it – and others can get it from surgery. It could have been a combination of the two for me.”
Tracy is recovering without any difficulties because he received the treatment he needed. Possible symptoms of DVT include leg or calf pain, swelling, and redness. Any concerns should be addressed to your primary care physician, immediately.

Holiday Feasting Underway!

2007-11-28T07:04:00.000-08:00

By Sarah Daubman, Registered Dietician

Thanksgiving for many people is the beginning of the holiday season and a time to reflect on their blessings. People gather together from near and far in celebration of family, tradition, love, gratitude and … okay, let’s not forget about the food. No doubt some of us are still loosening our belt buckles from last week’s Thanksgiving dinners. It’s not surprising with all the feasting associated with thanks and celebration that some of us escape the winter months with a few added pounds.

Unfortunately, year after year of seasonal overeating can contribute to obesity, as pounds gained are not always lost with the warmer months’ return. With more holidays on the way, temptation may still get the best of us – unless we prepare ourselves. This is not to say that special foods cannot be consumed in moderation. The difference is between enjoying and overindulging. Here are a few tips for holiday eating without the weight or the guilt.

On the day of a big dinner, don’t skip meals in preparation for an evening binge. Eat a healthy breakfast and lunch as you would everyday. This way hunger won’t lead to poor food choices and excessive portions.

Be careful of beverage choices as calories can quickly add up. Eight ounces of wine contains up to 160 calories, a serving of regular beer provides 150, 8 ounces of champagne yields 200, soda gives 136 and a cup of eggnog has nearly 350 calories!

If you’re hosting an event or bringing a dish to pass, substitute ingredients with healthier alternatives. Ideas include lower fat dairy choices for milk, sour cream and cheeses and sugar substitutes such as Splenda for baking. For meal preparation, try cooking sprays instead of butter, shortening and oil for greasing pans and cookware.

Bake only the sweets that you need for gifts or single occasions.

If turkey is on the menu again, try basting with low fat stock. Prepare gravy with the same. When enjoying it later, eat it without the skin.

This winter, get active by signing up for a 5K walk/run or similar fitness event, perhaps even for charity. Or make a contract with a friend to walk together during your lunch hour and after work. This kind of commitment provides motivation when exercise becomes less appealing with the colder months.

Enjoy healthfully prepared salads and vegetables as their high fiber content can help you feel fuller longer.

Experiment with new recipes. I’m a big fan of browsing web sites such as www.allrecipes.com and www.epicurious.com for their healthy living recipe collections.

Instead of food, focus on the real reason for the holidays: family.

Looking for Challenging Work?

2007-11-27T11:02:00.000-08:00

By Dana Pavelock, Dir. Home Care Operations

Personal Care Aide (PCA) and Home Health Aide (HHA) occupational shortages in the Hudson Valley region have increased as we experience significant aging trends for those in need of home care. In 2000, 12 percent of New York's residents citizens were 65 or older, a 3.6 percent increase since 1990. The U.S. Census Bureau estimates that by 2030 New York's elder population will increase by 60 percent to almost 4 million. By that year the traditional caregiving workforce (women aged 25 to 44) will decrease by 13 1/2 percent.

The U.S. Department of Labor recognizes Home Health Aides as the fastest growing of all occupations having expected a 56 percent growth in new jobs between 2004-2014. Bureau of Labor studies indicate national health care jobs are expected to grow by over 27 percent (twice the rate of other occupations). The industry certainly has its own challenges, experiencing a turnover rate of between 30 percent to 60 percent depending on what study you read. At the same time, the aging population wishing to remain at home requires more complex care that necessitates advanced training of Personal Care Aides (PCAs) to the Home Health Aide (HHA) level.

Finding, hiring, training and keeping PCA & HHA level staff has become one of the major focuses of all home health agencies throughout the state. Due to high volumes of turnover, enhanced supervision directives regulated by the state Department of Health, increasing salaries of nursing staff that are required to provide training and supervision accompanied by low and sometimes delayed reimbursement from contracts, agencies have had to adjust budgets accordingly in efforts to meet the increasing demands for services. Likewise, it has forced agencies to re-evaluate their recruiting practices and how to work with and retain aides after they are hired.

Since the beginning of 2007, our agency has hired over 70 new employees and has been fortunate to have received a grant that offers free PCA & HHA training classes on a monthly basis. This grant expects to train close to 300 students looking to re-enter the health care industry over the course of the one-year grant cycle. Part of the grant involves working collaboratively with the state Department of Labor, Dutchess County BOCES and other collaborators, to assist in helping the students secure work following training. Many of our new staff start out performing homemaker & companion duties, such as cleaning, cooking and shopping, and then attend a training course so they can take on personal care duties. Jobs created by the increase in demand for these workers are expected to produce numerous openings. Persons who are interested in this work and suited for it should have excellent job opportunities, particularly those with personal experience as a caregiver or those who have already participated in training as PCA/HHA or CNA.

The HHA/PCA’s daily routine may vary. Aides may be placed on assignments on a long-term basis (working with the same patient for months or years), some aides will work with several patients a day on a short-term basis and having access to reliable transportation is a necessity. Aides may spend a portion of the working day traveling from one client to another (travel time is usually not compensated but several agencies pay mileage reimbursement). The home environment varies as well with some assignments in upscale private homes while some others might be untidy or depressing. Most patients are pleasant and cooperative while others may be more challenging. Aides work somewhat independently having periodic supervised visit by registered nurses. They receive detailed instructions of when to visit patients and services to deliver. Aides can work anywhere from 2 hours to 40 hours weekly, depending on availability.

Successful aides like to help people and do not mind hard work. Unlike national trends 63 percent of our current workforce is over 45, with 29 percent 25 to 44 and just 8 percent 18 to 24. Twenty-five percent of our staff is over age 60 and one third are over 70, seniors assisting seniors. All aides need to be responsible, respectful, honest, compassionate and cheerful. In New York State, aides are required, at minimum, to have a complete physical exam, be in good health and required to have a criminal history record check.

Anyone interested in working with and supporting our aging population with a few extra hours a day available should contact a local home care agency to check employment opportunities. You couldn’t even begin to imagine the difference you can make in someone’s life and how rewarding this type of work really is!

Trip To Italy A Culinary Treat

2007-11-14T10:34:00.000-08:00

By Joanne Chaconis, RD

I have been absent from this blog site for a while. One reason is that I have lacked any creative ideas and the other reason is that I recently spent eight days vacationing in Italy.

Aside from the many ancient sites and beautiful natural landscapes I witnessed, a high point of this trip was sampling the foods. I visited many regions and cities – Rome, Florence, Venice, Naples and Capri, to name a few. All offered an abundance of foods to try. Every meal included one to two courses of fresh pastas, each served in a light red or white sauce. The pasta was thin, a true melt-in-your mouth feel. Prosciutto was served most nights, either with melon or fresh bread. I decided that too much of a good thing was not always good and I soon tired of it.

Main entrée choices always included fish, and the calamari in Venice was delightful, gently breaded and fried. Prior to that Venetian lunch I had not had calamari in 20 years and it was definitely worth that two decade wait.

The salmon served our last night in Rome was seared perfectly. Meat dishes always included a choice of veal. Since I never cook that at home, I always opted for it and was never disappointed with that decision. Desserts were fantastic and included the second best tiramisu that I ever tasted. My friend, Patty Sonsiadek from Fords, N.J., makes the best, hands down.

Earlier I mentioned prosciutto and “too much of a good thing.” That wasn’t the case with the wines. The red wines were light and complemented many meals!
I couldn’t help but notice that despite the abundance of good food and wine that seemed to be prevalent everywhere, there did not seem to be much obesity among the population. Many people seemed to get their exercise by walking a lot (with gasoline over $8 a gallon, I guess that’s a good reason).

My trip was wonderful. A smorgasbord for the mind, eyes and, of course, stomach!

Caio!

What to Know About Strokes

2007-11-01T05:44:00.000-07:00

By Susan Hecht, RN

Stroke.
Why is it important to know your risk factors for a stroke?
Prevention and education! Knowing your risk factors and understanding them is the key to prevention. We are all aware that there are some things that we are unable to modify in our lives; however let’s just talk a little about the things that can be modified by your physician, lifestyle modifications or possibly even medication if necessary.
A regular medical checkup with your primary physician is the first step. This visit can be used for education purposes as well as preventable measures if needed. The single most important thing to know is your blood pressure. Monitoring your blood pressure is the most preventative measure one can take. If it is high (140/90) notify your physician for medical follow up. Those with diabetes mellitus, heart disease, or other health issues should always follow up with their physician.
Some lifestyle modifications we are able to make are tobacco use, obesity, and excessive alcohol intake. Some signs and symptoms of a stroke are as follows: sudden numbness or weakness of the face, arm, or leg (especially one side of the body); sudden visual problems (difficulty seeing in one or both); sudden dizziness or difficulty walking or loss of balance; severe headache with no known cause; sudden difficulty speaking; and sudden difficulty in understanding something.
If experiencing any of the above symptoms, don’t take a chance dial 911 immediately. For further information regarding strokes and or further signs and symptoms; discuss them with your primary physician or call the American Stroke Association at 1-800-4STROKE.

Of and About Fiber Consumption

2007-10-18T13:17:00.000-07:00

By Sarah Daubman, Registered Dietician

According to the American Heart Association the average American consumes about 15 grams of fiber per day. What is the actual goal for fiber consumption? The recommended intake for men is 30 -38 grams per day, 21-25 grams per day for women. Reaching this goal is not as hard as you may think, but first let’s talk about what fiber is and why it’s important.

Fiber is a carbohydrate that can not be broken down by digestion therefore it provides no calories or nutrients. Fiber is found in plant foods such as fruits, vegetables, whole grains, legumes (beans and peas), nuts and seeds. The two kinds of fiber are soluble and insoluble. Soluble fiber, which dissolves in fluids, thickens substances. Inside the body this type of fiber binds with fatty acids and prolongs stomach emptying time. Oats, peas, beans, apples, corn, carrots, citrus fruits and potatoes are sources of soluble fiber. Insoluble fiber does not dissolve in fluids and provides bulk inside the intestines, resulting in softer bowel movements. Higher intake may help relieve constipation. Insoluble fiber is found in whole grains, brown rice, seeds, nuts, leafy green vegetables and seeds.

Both types of fiber are important and adequate intake is associated with many health benefits. It can help with weight control as fiber makes you feel fuller for a longer period of time making overeating less likely. High fiber foods also tend to have fewer calories per serving than less fibrous foods. Fiber can also prevent and treat constipation by helping form softer, bulkier stools. Less straining during bowel movements may reduce the instances of hemorrhoids and diverticular disease. Additionally, high fiber diets may help with elevated cholesterol because soluble fibers bind with cholesterol as they pass through the intestinal tract, reducing the amount in the bloodstream.

So how much fiber are you consuming? You can check the nutrition facts label on most foods or check the link for a fun fiber intake calculator. A few words of caution: If you are going to increase your fiber intake, do so gradually. Too much fiber at once can cause bloating and gas. Also be sure to drink enough fluids, 8 – 10 cups per day.

http://www.fiberchoice.com/eating/calculator.asp

Geriatric Case Management: Do I Really Need Direction

2007-10-17T09:43:00.000-07:00

By Dana Pavelock

Are the problems that you or your loved ones are facing becoming larger and more complete than you can comfortably manage? Are other demands and responsibilities now so great that you are not able to provide the desired level of supervision and attention to your loved one’s
problems.

For the past two decades, Geriatric Care Management has been a popular services that has been well utilized; especially in more urban and metropolitan areas. Understanding the complexities of the health care system and finding the time to coordinate care for a loved one can be a very overwhelming task. In communities such as ours we have been fortunate in being able to navigate through most of the planning and care needs via services from the Dutchess County Office of the Aging, Home Care agencies and knowledgeable hospital and nursing facility social work and discharge planning staff.

However, in just the past few years we have begun to see a significant shift with more individuals requiring additional assistance and ongoing support as the health care industry continues to diversity. Fortunately, information available now through the Internet makes navigation somewhat easier than in the past but still, lifestyles of the sandwich/baby boomer generation often leave very little time to thoroughly assess medical conditions, home safety considerations and how to access appropriate services for a loved one.

What can a Geriatric Care Manager do for you? How do you find a Geriatric Care Manager, and how much will it cost? Are Home Care agencies equipped to handle Geriatric Care Management services? Typically agencies and individuals offering Care Management may include but are not limited to the following services:
Conduct comprehensive health assessments to identify problems and to provide solutions; screen, arrange, and monitor in-home help or other services; provide short or long-term assistance for caregivers living near or far away; review financial, legal, or medical issues and offer referrals to geriatric specialists; provide crisis intervention; act as liaison to families overseeing care, and quickly alerting families to problems; assist with moving to or from a retirement complex, assisted care home, or nursing home; provide consumer education and advocacy; offer individual and/or family counseling and support; 24 hour crisis intervention; coordinate practical daily services, paying bills and daily money

Understanding Acute Rehabilitation

2007-10-16T11:08:00.000-07:00

By Susan Hecht, RN

A family member asked recently what exactly we do on our rehabilitation unit. I thought for a minute about how best the community would understand the importance of a Comprehensive Integrated Inpatient Rehabilitation Program. So I explained to this family member that our mission is to assist individuals with achieving their highest potential for recovery and enable them to return to their homes and communities.

After a few minutes, she asked me what types of services we offer. I explained that we offer many including physical therapy, occupational therapy, speech therapy, pet therapy, family education services, home assessments, support groups and many more. She was impressed with the services I mentioned. “I had no idea you offered all those services on that unit,” she said. I explained that we are also accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). I offered to take her as well as other family members on a tour of the unit. They agreed, I showed them around and they were very impressed.

About three months later I was called on a consult for a patient who was recommended for our acute rehab here at Saint Francis. It happened to be the husband of the family member who had asked me about our services. He was admitted to our unit for rehabilitation after a stroke. He participated in three hours of therapy daily, and also in our Stroke Support Group. While he has returned home, he continues to come in on Fridays to our Stroke Support Group.

His wife very grateful for that one day someone took the time to explain what the Rehabilitation Unit is all about. Little did she know, at that time, that she and her husband would have need of our services just a few months later.
Education is a very important part of nursing today. Making sure the community understands how and what we do here at Saint Francis is and will continue to be a very important role for me. And, yes, that education can include your relatives.

Understanding Vegetarian Diet(s)

2007-09-27T07:54:00.000-07:00

By Sarah Daubman, R.D., Staff Dietician

In June of this year I decided to adopt a vegetarian diet. I had attempted the same a few years ago, but did not stay with it in the long run. My interest was renewed after reading T. Colin Campbell’s The China Study, which I would recommend to anyone interested in nutrition research, vegetarianism or disease prevention.

Initially, I challenged myself to stick with it for 30 days. Thirty days has turned into three months and I still remain committed. The benefits of a vegetarian diet have long been clear. In 1997, the American Dietetic Association released their position paper on vegetarian diets stating “that appropriately planned vegetarian diets are healthful, are nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases.”

The paper goes on to describe the lower incidence rate of diseases in vegetarians than non-vegetarians. Specifically, vegetarians are less likely to have coronary artery disease, type II Diabetes Mellitus and lung and colorectal cancer. Also, vegetarians often have lower cholesterols and blood pressure and weigh less than their meat-eating counterparts.

There are different types of vegetarians. Vegans consume no animal products, including meat, poultry, seafood, dairy, eggs and honey. Lacto-vegetarians eat dairy but no meat, seafood or eggs. Ovo-vegetarians eat eggs but no dairy, meat or seafood. You may have heard some newer terms such as “flexitarian” or “semi-vegetarian.” These persons may limit their intake of certain types of meats or seafood, or only eat meat at limited times, for example, red meat once a week. Whether this reflects the true ideal of vegetarianism can be debated.

As noted in my earlier posting I am a lover of the culinary arts as well as nutrition. Trying new recipes is my favorite part of the new lifestyle and I hope to share some with you as this blog progresses. My goal is not to convert the reader, but rather encourage some new dishes at the dinner table. I promise they will not all be about rutabagas.

About The China Study:

http://www.amazon.com/China-Study-Comprehensive-Nutrition-Implications/dp/1932100660/ref=pd_bbs_sr_1/002-6800051-2080043?ie=UTF8&s=books&qid=1189043289&sr=8-1

American Dietetic Association Position Paper on Vegetarian Diets:

http://www.vrg.org/nutrition/adapaper.htm

Care-Givers! Give Yourself A Break

2007-09-26T11:09:00.000-07:00

By Dana Pavelock, Director of Home Care Operations

10 Commandments for Care-Givers
1. Be True To Yourself 2. Know Your Limits 3. Make Time for Yourself 4. Know When to Say No 5. Know When To Ask For Help 6. Know When To Get Counseling 7. Have Empathy, Not Sympathy For Your Care Recipient 8. Have Compassion olr Them And Yourself 9. Enlist Your Family Support 10. Create Support for Yourself

Roughly 25 percent of families are relying on informal family caregivers to bridge the needs of caring for a loved one at home. Today, 30 million households are providing care for an adult over the age of 50 and this number is expected to double over the next 25 years. This informal and highly motivated workforce of caregivers often find themselves struggling to navigate a very complex system of health care and are under a great deal of stress. Informal caregivers tend to be family members, mostly women between age 45 and 65, attempting to balance the needs of parents and grandparents with children and grandchildren. Often these individuals find themselves suddenly immersed in the role of caregiver without warning, preparation and/or training and are at risk of compromising their own health care and social needs. Rarely is there a support system for them. As the aging population continues to grow at a very fast rate there will be more and more demands placed upon family caregivers. Combined also with a higher life expectancy and with the trend for the aging population to want to remain at home, we will need ongoing support from local county, government and private agencies.
Some of you reading this may not be in a care-giving role at this time. While you might not be thinking about it now, being proactive and establishing a plan now, in anticipation you will soon be launched into caring for a family member may help avoid some of the stress and other tensions that materialize both at work and at home. The first step should begin with discussing with having a conversation with your and the person you expect will require more care and support to live safely at home, identifying potential support and services that are readily available, anticipating care needs and establishing a plan. All too often, one person takes on the primary role as caregiver which often leads to physical and emotional exhaustion and can result in development of increased health risks to the caregiver.
Fortunately there is help available for individuals who find themselves suddenly in that care-giving role. The best resource is to start by contacting your counties Office for the Aging, surfing the internet and reaching out to home care agencies for help. There is a wealth of information that will provide you with the necessary tools and support you may need so that you can take good care of a loved one and at the same time help maintain your own quality of life. As you might expect, it takes a very special person to fulfill the role of caregiver. In our particular agency, we have long recognized the value of both paid and unpaid family caregivers, recently obtaining a grant through the Dutchess County Office of the Aging to lead a Caregiver Support, Training and Counseling program that provides various workshops, trainings and even an employee to provide one on one visitation in the home, free of charge for caregivers.
When it comes to paid caregivers, please do not underestimate their genuine concern and passion for what it is they do every day. Relationships that are formed between patients and our caregivers is priceless and can be captured by quoting a few words taken from a poem written by Sharon Greene, Home Health Aide; “I am a health care worker, I enjoy my job and this is what I do best. Put a smile on someone’s face, making their day and just being there for them.”

Let's Get Drunk and Drive

2007-09-21T08:31:00.000-07:00

By Cynthia Leslie, MD, FACS
Drinking and driving is as American as baseball and apple pie. Alcohol is our drug of choice and boy do we abuse it. Most of the time we’re lucky and people don’t get hurt. But, people who aren’t so lucky end up in the Trauma Center.

Think about it this way, Most of the people we know are fine, upstanding citizens that happily look down their noses at IV drug abusers. Most of those very same people have gotten very drunk. Not only have they gotten drunk, they’ve driven drunk to boot. We hear it all the time- “I only had two beers,” “I know how to handle my liquor,” and “I’m not an alcoholic.” The blah and the blah and the blah, never seem to end. But guess what fine, upstanding? You were drinking and someone is dead.

Here at the Trauma Center, we see patients in distress. We hear screaming and crying, pleading and dying and everything in between. We know that a lot of patients are unfortunate, innocent victims. But many of our unfortunate patients were drunk and incredibly stupid. We see every type of drunkenness that drinking has ever produced, but the drinker we see most often is The Drunk Who Isn’t Drunk. This amazing human being is a marvel to behold. He’s too drunk to tell you his name. He’s too drunk to tell you his age and when you ask him where he lives, he can’t remember that either. He took out a tree at a high rate of speed, and he killed his childhood friend. He’s The Drinker Who Isn’t Drunk and he doesn’t know how it happened.

We also take care of the drinker who’s Only An After Work Drinker. As soon as this drinker leaves her job, she drinks herself to sleep. From 6 p.m. through 6a.m., she’s as drunk as drunk can be and whenever she goes for a drive, bad things tend to happen. When she ends up in the trauma room, she asks the age-old question. But, I’m Only An After Work Drinker – how could this have happened?

And then there is the ultimate drinker, The Drinker Who Knows How To Kill. They murder your sweetheart, or husband. They murder your wife and kids. They also dismember your mother and leave your father face down in a ditch. The Drinker Who Knows How to Kill, look like normal people. They binge on booze on weekends, or they drink throughout the week. However they choose to do it, they’re drinking to get drunk and every time they tie one on, they always want to drive.

Now the last thing a drinker should do is go for a drive while drunk, but no matter how often we say it, no one seems to listen. People get on their ATVs and ride their motorcycles. They jump into their motorboats and rev up the engines. It almost makes me wonder why the trauma team makes a fuss. Perhaps we should all start drinking, just like out drunken patients.

So here’s to driving drunk and not caring about our children. Here’s to driving drunk and murdering all our neighbors. Here’s to driving drunk and becoming a quadriplegic. Here’s to driving drunk and learning to be a widow. Every time we drink and drive, we’re sure to have some fun. Here’s to drinking and driving and killing the people we love.

DVT: The Silent Killer

2007-09-13T11:10:00.000-07:00

By Susan Hecht, RN, Nursing Rehabilitation Liaison

Deep vein thrombosis affects up to 2 million Americans each year. DVT is a blood clot that forms in the deep veins of the legs, usually leading to either partially or completely blocked circulation. If untreated, this clot has the potential to travel to the lungs and block circulation to vital organs.

Learning the preventable measures and becoming aware of the disease will decrease the possibility of having a DVT. I have taken a special interest in this topic because I do not feel there is enough education in the community regarding deep vein thrombosis. Most people have never heard of DVT. The key prevention is AWARENESS. Learning who is at risk and why is a very important step in learning how to prevent becoming a DVT victim.

DVT is often caused by immobilization, trauma and surgery. Some of the more common symptoms are pain and swelling in the legs. Preventative measures include early mobilization, compression devices to promote blood flow and/or anti-coagulation therapy prescribed by your physician.

At Saint Francis Hospital, we’ve taken on the challenge of spreading awareness about DVT. We will be hosting a DVT Awareness Day on Thursday, Sept. 20. We will be joined by Melanie Bloom, widow of the late NBC Correspondent David Bloom who died in the early stages of the Iraq War from DVT complications. Melanie Bloom, the national spokesperson for the Coalition to Prevent DVT, will participate in a DVT Awareness presentation and question and answer session from 11:30 a.m. to 12:30 p.m. at our Atrium Community Conference Center.

This event is free and open to the public, but registration is encouraged. Please RSVP at 845-483-5777.

My Father’s Daughter or, the Importance of Proper Hydration

2007-08-27T12:58:00.000-07:00

By Joanne Chaconis, R.D.
I think I am a lot like my dad…same sense of humor, just as stubborn and we both love sweets. Practically a carbon copy, with a few exceptions. One of those exceptions? I drink fully enough fluids daily to keep me well hydrated. My dad, on the other hand, is not as diligent. Every conversation that I have with him always includes reminders (some gentle, some not-so-gentle) of the importance of drinking enough fluids.

This seemed to be an important and timely topic to discuss. Timely because of the summer season we are now enjoying. There are many factors that increase our need for fluids and they include: excessive perspiration, fever, vomiting, diarrhea and hyperventilation. I should also mention here that under some medical conditions (such as certain cardiac and renal diseases) your fluid needs may actually decrease. Always check with your physician.

A general rule to follow when determining fluid needs for a healthy individual (according to the Committee on Dietary Reference Intakes) is:

Age in years ml/kg (wt)

Young, active (16-30) 40

Average activity (25-54) 35

Older (55-65) 30-35

Older (>65) 25-30

Here is an example: To convert ml to ounces, divide by 30.
To convert kg to pounds, divide by 2.2.

A 50 year-old adult weighing 150 pounds:

150 pounds divided by 2.2 kg = 68 kg
68 kg x 30-35 ml = 2040-2380 ml
2040 – 2380 ml divided by 30 ml = 68-79 ounces, which translates to between 8 ½ to 10 eight ounce servings daily.

Best beverage choices are water, sugar-free juices and sodas and decaffeinated beverages. Also fruits are a good choice because they are about 20 percent water-packed.
So…toast a loved one (here’s to you dad!) with an eight ounce glass of cool water and stay hydrated!

It Only Takes A Second

2007-08-27T12:50:00.000-07:00

By Cynthia Leslie, M.D.
Most people would probably tell you that a second is very short, but I think time is relative and it depends on what you do. I work in Saint Francis Hospital’s very busy Trauma Center, and I am constantly reminded that seconds are very precious. The trauma team treats thousands of patients who have been harmed in different ways. Some have been injured in car crashes and some have been shot or stabbed. A number of our elderly neighbors require treatment due to falls. Whatever the injuries are, there is always a common denominator. Patients need our help and we have seconds in which to give it.

When patients arrive in the trauma room, the trauma team is ready. We first look for life-threatening injuries that require immediate treatment. If a patient has trouble breathing, her lung could be collapsed. If the patient has internal bleeding, he may present with signs of shock. When the body is oxygen deprived, the brain is extremely vulnerable and brain death can occur in as little as four to six minutes. The trauma team’s job is to immediately assess, resuscitate and treat and we do all of that very quickly because we know that seconds count.

Trauma is the number one killer of our youngest and healthiest neighbors. It is also a merciless scavenger that maims the old and frail. Heart disease and cancer are widely known public health problems, but the grisly toll that trauma takes frequently goes un-noticed. Hundreds of thousands of people have died on U.S. highways. Hundreds of people die every day as the result of senseless violence. Trauma is more than an injury. It is a national epidemic and until we acknowledge the damage it does, we won’t do much about it. People are driving way too fast and people are much too angry. If you think that rage and speed don’t kill you need to think again. Trauma is killing our youngest, our oldest, our best and our brightest. We need to address the problems and we need to do it now.
It only takes a second to crash into a tree, but that second could be avoided by driving a bit more slowly. It only takes a second to hit and kill a child, but that second could be avoided by refusing to drink and drive. It only takes a second to remember to use your seatbelt and it takes another second to tell your children to do the same. If we use our seconds wisely we will save our neighbors’ lives. What better way to use them when it takes so little time

Honoring Home Care's Unsung Heroes

2007-08-27T12:47:00.000-07:00

By Dana Pavelock
We often get calls and questions about Personal Care Aides and Home Health Aides. The general public has developed their own perception based on a slew of articles that may or may not really capture the essence of who these people are and how important the work is that they do. This has often led to misconceptions about the level of training or skills of these workers.

For the most part, individuals performing this level of para-professional health care service consist of a group of people who have a commitment to caring for others. They are men and women of varying ages and backgrounds who understand the vital role that they serve. They provide services and care to individuals on either a short term or long-term basis to improve quality of life, preserve dignity of self and maintain patient’s ability to remain home for as long as they choose. Services range from companionship to total care, one hour a day to live in aides, with settings ranging from plush private homes to inner city projects. Home Health Aides and Personal Care Aides experience much satisfaction providing care and develop wonderful relationships with patients and family members alike, and at the same time often are under appreciated for who they are and what they do.

PCA’s and HHA’s are required to complete training classes ranging from seven days to two weeks in length through a health training curriculum that is approved by the Department of Social Services and the NYS Department of Health. Some of the training consists specifically on working with children and disabled population, meal preparation, complex diets and nutrition, spending & budgeting, care of the home & personal belongings, infection control, personal care related to bathing, dressing, grooming, ambulating and transferring patients, use of mechanical lifts and other medical equipment, and assisting with medications.

HHA’s receive enhanced training in areas such as how to measure vital signs, prepare complex modified diets, assist with prescribed exercise programs, use other prescribed medical equipment, provide special skin care, and assist with dressing changes. The training is very detailed and students not only have to complete the training, they need to pass academic testing and demonstrate competency in each module. They are also required to participate in on-going in-service training throughout the year and demonstrate competency in the field under the direct supervision of a Registered Nurse. For more information regarding the training curriculum and to see exactly what services and activities are permissible by a Home Health Aide please visit the following site: www.nyhealth.gov/ and search Home Health Aide Training.

Like other agencies that deliver HHA & PCA services, every week we receive positive feedback from patients we serve who express high levels of satisfaction in for the services of our aides, who routinely go above and beyond the call of duty. HHA & PCA staff never cease to amaze us with their focus on providing exceptional care and customer service, doing so from the heart without seeking recognition. In many ways they are the unsung heroes in our health delivery system.

Please help the health care community recognize the valuable and important role our home care aides provide. We ask that you simply understand the work they do and whenever you have the opportunity, let them know how appreciated they are for what they do.

A Visit With Mom And Rutabagas

2007-08-23T13:26:00.000-07:00

By Sarah Daubman, R.D.

Not too long ago I sat with my mother at her kitchen table drinking coffee. Somehow the conversation turned to childhood memories, particularly those involving food and favorite recipes. “Do you know what I haven’t had in almost twenty years?” she asked. “Rutabagas.”

She went on to describe how much she loved the mashed rutabagas she enjoyed as a child. Being a dietitian and lover of food in all ways, my curiosity was piqued. Though I pride myself on the willingness to try just about any exotic, gourmet food, I could not recall ever having a rutabaga, a simple, humble vegetable at best. I questioned my mother: Is a rutabaga the same as a turnip? How do you cook it? What does it taste like?

Of course I had to research some of this information on my own. As it turns out, the rutabaga is not the same as a turnip, though they are closely related and rutabagas may be referred to as “yellow turnips.” Rutabagas are round root vegetables with yellow-orange flesh around the top and white/yellow skin around the bottom. If searching for them in the grocery store, which I later found myself doing, you will likely find them next to the turnips. Their color and larger size should help differentiate the two.

Upon returning home with the newly purchased vegetable, I set upon making mashed rutabagas for my mother. The rutabagas had a waxy covering that easily peeled away with the skin using a vegetable peeler. The next task was not as easy – cutting the rutabagas. I used a large chef’s knife to slice the root vegetable in half and then into smaller and smaller pieces. I added the 1-inch cubes to a pot of water, brought the water to a boil and cooked them until easily pierced with a fork.

Based on the recommendations of my mother and other researched recipes, I treated the cooked rutabagas much like potatoes. As many ways as there are to make mashed potatoes, so there are for mashed rutabagas. My mother’s preference was milk, butter, salt and pepper. Upon presenting the dish to her she was delighted to find them as a good as she remembered. I have since discovered other methods of preparation: mashed alone or with potatoes, turnips or squash, roasted with olive oil and herbs, grated into salads or cole slaw, diced into soup or caramelized with onions.

I find the rutabaga to have a distinct flavor, tastier than the mild turnip in my opinion. Of course, the nutritious side of rutabagas should also be mentioned (see link: http://www.vegparadise.com /highestperch4.html). I encourage you to experiment with your own recipes. If taken the time, I’m sure you will find the rutabaga a wonderful addition to your family’s meals and discover, as I did, it is a vegetable not only your mother will love.

Bright Sunshine Equals Horrible Sunburn

2007-08-23T13:07:00.000-07:00

By Susan Hecht, R.N.

I have to tell you, at times this summer it has been extremely hot. During one of those hot spells I had an experience with my friend, Ryan, and the hot weather. I work inside so I am fortunate enough to have an air conditioner to keep me cool. Anyone that works outdoors that I know I always express my concerns regarding sunburns and heat exhaustion. Those things that go with this wonderful summer-time weather.

Ryan is in the process of building a house. Well, he tells me that he is going to work on his house the following day. I watch the weather and see the forecast calls for a high temperature of 96 degrees. Keeping in mind that the work he is preparing to complete is OUTSIDE work, I explain to him about making sure he has plenty of water, sun block and to wear a shirt to prevent sunburn.

I must say that men are the worst when it comes to wearing sun block. I expressed my concerns about heat exhaustion, having plenty of water, taking breaks out of the sun – in an air conditioned area, if at all possible – and wearing light clothing. I would love to hear of any man who would listen to all these instructions before going outdoors to work!

Well, I must say that evening after spending a day with NO shirt on, very little to drink (I’m sure) and working on the outside deck of the house for about 5 straight hours - with no break from the sun – my friend began to complain about having the chills. You could feel the heat coming off his back.

So I asked – did you drink enough water? Did you wear a shirt? Did you take breaks out of the sun? His reply was that he needed to get the house done and I don’t have time for breaks. And, of course, he had taken off his shirt because it was so hot!

Needless to say, Ryan spent the next two days in pain with discomfort and NO work was done on the house during that time.

When he did get back to working on the house he was well armed with sun block, a jug of water and wore a light shirt. He took frequent breaks during which he applied more sun block.

It is summer time, let’s remember the things we don’t focus on with the nice weather. The sun burns so use sun block. To combat dehydration drink plenty of water or other non-alcoholic beverages. Take breaks out of the sun, preferably in air-conditioned areas. If you feel dizzy or faint see a doctor immediately. As for Ryan, he continues to work on the house but he hasn’t burned since that day.